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Deaths in critical care and hospice—prevalence, trends, influences: a national decedent cohort study
  1. Jonathan Mayes1,2,
  2. Stela McLachlan1,
  3. Emma Carduff3,
  4. Joanne McPeake4,
  5. Kirsty J Boyd1,
  6. Natalie Pattison5 and
  7. Nazir Lone1,2
  1. 1Usher Institute, The University of Edinburgh, Edinburgh, UK
  2. 2NHS Lothian, Edinburgh, UK
  3. 3Marie Curie Hospice Glasgow, Glasgow, UK
  4. 4School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
  5. 5University of Hertfordshire, Hatfield, UK
  1. Correspondence to Dr Nazir Lone, Usher Institute, The University of Edinburgh, Edinburgh EH8 9AG, UK; inazir.lone{at}ed.ac.uk

Abstract

Objectives End-of-life and bereavement care support services differ in critical care and inpatient hospice settings. There are limited population-level data comparing deaths in these two locations. We aimed to compare the characteristics of people who die in critical care units and in hospices, identify factors associated with place of death and report 12-year trends in Scotland.

Methods We undertook a cohort study of decedents aged ≥16 years in Scotland (2005–2017). Location of death was identified from linkage to the Scottish Intensive Care Society Audit Group database and National Records of Scotland Death Records. We developed a multinomial logistic regression model to identify factors independently associated with location of death.

Results There were 710 829 deaths in Scotland, of which 36 316 (5.1%) occurred in critical care units and 42 988 (6.1%) in hospices. As a proportion of acute hospital deaths, critical care deaths increased from 8.0% to 11.2%. Approximately one in eight deaths in those aged under 40 years occurred in critical care. Factors independently associated with hospice death included living in less deprived areas, cancer as the cause of death and presence of comorbidities. In contrast, liver disease and accidents as the cause of death and absence of comorbidities were associated with death in critical care.

Conclusions Similar proportions of deaths in Scotland occur in critical care units and hospices. Given the younger age profile and unexpected nature of deaths occurring in critical care units, there is a need for a specific focus on end-of-life and bereavement support services in critical care units.

  • hospice care
  • bereavement
  • hospital care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Since analyses involved data on unconsented participants, we are unable to share individual-level data.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Since analyses involved data on unconsented participants, we are unable to share individual-level data.

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Footnotes

  • Twitter @ICUlone

  • Contributors All authors made substantial contributions to the conception or design of the work. JM, SM and NL undertook the analyses. JM, SM, NL and NP drafted the work. All authors revised the work critically for important intellectual content and granted the final approval of the version to be published. NL gave agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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